Provider Demographics
NPI:1316123912
Name:FOUNDATION WEIGHTWISE SERVICES, LLC
Entity type:Organization
Organization Name:FOUNDATION WEIGHTWISE SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MORTON
Authorized Official - Last Name:BYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-608-1700
Mailing Address - Street 1:1800 RENAISSANCE BLVD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3023
Mailing Address - Country:US
Mailing Address - Phone:405-359-2473
Mailing Address - Fax:405-359-2499
Practice Address - Street 1:1800 RENAISSANCE BLVD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3023
Practice Address - Country:US
Practice Address - Phone:405-359-2473
Practice Address - Fax:405-359-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty